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Classification of Neuropathic Facial Pain
· Classic Trigeminal Neuralgia, type 1, (TN1): (also known as tic douloureux) facial pain of spontaneous onset with greater than 50% limited to the duration of an episode of pain (temporary pain). TN is often caused by loss of or damage to the nerve’s protective coating, (myelin). The most widely accepted view is that myelin damage results from irritation of the nerve, usually a blood vessel that causes the nerve to be compressed.
· Trigeminal Neuralgia, Type 2, (TN2): facial pain of spontaneous onset with greater than 50% as a constant pain.
· Secondary Symptomatic Trigeminal Neuralgia (STN): Pain resulting from multiple sclerosis.
· Post- Herpetic Neuralgia (PHN): pain resulting from herpes zoster outbreak (SHINGLES) along the trigeminal nerve.
· Trigeminal Neuropathic Pain (TNP): facial pain resulting from unintentional injury to the trigeminal system from facial trauma, oral surgery, ear, nose and throat (ENT) surgery, root injury from posterior fossa or skull base surgery, stroke, etc. This pain is described as dull, burning, or boring and is usually constant because the injured nerve spontaneously sends impulses to the brain. The injured nerve is also hypersensitive to stimulation, so attacks of sharp pain can also be present. The area which is sensitive to touch and triggers these sharp attacks is the same area where the pain occurs. Numbness and tingling are also signs of a damaged nerve.
Trigeminal Deafferentation Pain (TDP): facial pain in a region of trigeminal numbness resulting from intentional injury to the trigeminal system from neurectomy, gangliolsys, rhizotomy, nucleotomy, tractotomy, or other denervating procedures. Despite the loss of sensation, constant pain is felt in the numb area(s), which varies in intensity and can include sensations of burning, crawling, tingling, boring, stinging, and/or unpleasant aching.
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